"TRASH" Lesions of the Pediatric Lower Extremity

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Stephanie Holmes, MD


TRASH lesions have been coined as a group of pediatric elbow injuries which are underappreciated on radiographs, and which “if treated insufficiently result in chronic long-term consequences.”1 We describe a series of injuries in the pediatric lower extremity, which are similar to elbow TRASH lesions, in that they are often overlooked or dismissed as inconsequential and may have serious ramifications if managed inappropriately. These injuries include traumatic hip dislocations with subsequent intraarticular pathology, greater trochanteric avulsion fractures, patellar sleeve fractures, minimally displaced proximal tibial metaphyseal fractures, and minimally displaced Salter-Harris III and IV fractures of the medial malleolus. Making the correct diagnosis and implementing appropriate treatment, including adequate follow up, is paramount.

Key Points:

  • Traumatic hip dislocations in the pediatric and adolescent hip populations can result in intraarticular pathology, which is not visualized on advanced imaging.

  • Greater trochanteric avulsion fractures, while rare, may be complicated by avascular necrosis of the femoral head.

  • Patellar sleeve fractures may be easily missed on radiographs, and inadequate management can result in significant sequelae.

  • Proximal tibial metaphyseal fractures, even when nondisplaced, may result in posttraumatic genu valgum, and caregivers should be warned of this possibility.

  • Non- and minimally displaced Salter-Harris III and IV fractures of the medial malleolus can lead to premature physeal closure, and radiographic follow up of these injuries is warranted.

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